Lecture 3: Factors for poor fetal outcome(s) Flashcards
What is considered full term
39-40 weeks
What is considered early perterm?
What is considered late pre term?
Does birth weight convert to how much you’re going to weigh when you’re older?
No
What is considered an extremely low birth weight?
2.2 pounds
What is considered an average birth weight?
5.51=8.82
KNOW: low birth weight = increased risk of death
Earlier their born = lower birth weight = increased risk of death
What is the leading cause of infant mortality?
Low birth weight
What is considered high birth weight?
8lbs 13 oz+
Shoulder dystocia = shoulders getting caught when coming out
Meconium aspiration = swallowing first shit because they’re in there longer
Are their long term poor outcomes w/ high birth weight?
No
What is the APGAR scoring system and what does it tell you?
* What is a perfect score?
Scoring system to see if the baby needs immediate help
Done right after they’re born
Not a predictor of long term outcomes
KNOW: Babies HR should be very high
10 = perfect and what we want
Overall Motality for babies
5.87
States w/ lower = longer trip to hospital / decreased education / food
TEST Leading causes of infant mortality
1) Perterm birth and low birth weight
2) Congenital malformations, deformations and chromosomal abnormalities
3) Sudden infant death syndrome
4) Materanl pregnancy complications
5) Injuries (suffication etc..)
Why did SIDS decrease in the 90s
back to sleep
KNOW: Assisted delivery - this is forceps or vacuum extraction
Intraventricular hemorrhage (brain bleed)
Scalp wounds
Brachial plexus injury
Collarbone or other fractures
Skull Fx
Bleeding within the skill
When does the neural tube close? if it doesnt close what happens?
* What prevents it
Closes at 6 weeks
Causes Spina bifida / anencephaly
50-70% can be prevented by folic acid daily before and in beginning of pregnancy
* % went down in 98 because cereals had folic acid –> rates are going up again because people are staying away from carbs/other grains
When do most people get prental care?
Smoking is associated w/ birth defects - people used to do this to lower birth weight
* think lower birth weight
fetal alcohol syndrome symptopms
What are the 4 fetal alcohol spectrum disorders?
1) Fetal Alcohol Syndrome - encompases almost everything, can see it in the facial features etc..
2) Partial Fetal Alcohol Syndrome
3) Alcohol related birth defects
4) Alcohol releated neurodevelopmental deficits
All 3 dysmorphic facial features
and then the other 2
1) Smooth Philtrum
2) Thin vermillion border
3) Small Palpebral fissures
Growth deficits
CNS Abnormality
To have fecal alcohol syndrome you need to have all these
NAS = babies adicted to substances
TEST These are medications
A) = rare because its studies in actual pregnant women
X = probs going to do something bad but might left you survivie
TEST What did folidimide do?
Given in the 50s for nausea, leads to limb defects
Class X
TEST Methotrexate is what class of medication?
X
TEST Acetaminaphen is what class of drug?
B
Know the class for the more commonly used ones
Maternal obesity side effects: (29.99+)
1) Miscarriage / Stillbirth
2) Birth defects
3) Macrosomia (big baby) (can lead to the baby getting those issues when coming out)
4) Preeclampsia (maternal)
5) Gestational diabetes (materanl) - don’t have to be obese for this
6) Preterm birth (basically everything causes this)
7) Future obesity and heart disease
Maternal underweight / Low BMI side effects
1) Breech Delivery
2) Low birth weight
3) Per-term birth (not typically below 32 weeks)
Less risk:
* Induced labor
* C-section
* Postpartum hemorrhage
APGAR scores not typically affected
What is Toxoplasmosis?
* How is it contracted?
Parasite that can affect anyone, but if it affects a pregoo woman than the baby is likely to be affected
Ingestion of raw or undercooked contaminated meat
Exposure to T, gondii oocysts through CAT LITTER - we tell pregnant women not to deal w/ cat litter
Exposure to T. gondii oocysts through soil
Contaminated water
leads to muscle pain, fever, HA in mother
Stillbirth / miscarriage
Blindness
Seizures
Developmental delay
Cytomegalovirus
* what percent of adults over 40 have this?
* 5 problems
* Signs at birth
* Happens in how many birth
* How many of those babies w/ CMV ahve long term health issues?
50% of adults over 40 already have this
Problems:
* Hearing loss
* Developmental and motor delay
* Vision loss
* Microcephaly
* Seizures
Signs at birth
* Rash
* Jaundice
* Intrauterine growth resitrction
* Hepatosplenomegaly
* Microcephaly
* Seizures
* Retinitis
1/200 live births have this
1/5 babies w/ congential CMV have long term health issues
* So being exposed to it doesnt mean they’ll 100% have issues
What two ways is zika transmitted?
* 2 things it causes
Transmitted by mosquitos and sexual activity
Causes:
* Microcephaly (small head)
* Severe fetal brain defects
No current outbreaks (since 2019)
KNOW: once you get over 40 your much more likely to have adverse events in pregnancy
Are you at increased risk of congenital malformation and stillbrith w/ age?
No
Is Austim chance increased w/ age?
Yes
Is multiple birth increased w/ age?
Yes, mom starts pumping out more eggs
KNOW: mean age of mothers is getting older
Does downsyndrome increase w/ mothers age
Significantly
NOTE: you can still have this when young, just much increased chance w/ mothers age
* Once mother is 40 all of mothers pregnancyies are classified as high risk
* 35+ = geriatric pregnancy
chromosomal anamly much more increased
KNOW: Risk of behavories issues in the child goes up w/ mothers age
* behavior problems go down w/ mothers age
this is the # of women having babies by age
NOTE teen pregnancies are down and older women are having more pregnancies due to fertility treatment
These things change w/ paternal age (not maternal)
NOTE austism is a catch all term
Does fathers age affect biolar disorder or autism?
both!
dads age vs biopolar
Correlation does not = causation
If you are pregant w/ multiple babies what is the risk for prematurity / low birth weight?
60% chance (bad because low birth weight is correlated w/ mortality)
Why is the mom at 2x risk for congential deficits including spina bifida and neural tube defects when pregant w/ multiple babies?
Because the mom can only absort so much folic acid / other nutrients
Why is the baby at increased risk for intraventricular hemmorrhage leading to cerebral palsy when twins / multiple pregnancies?
I think its in birth something happens with getting both out?
Twin to twin transfusion syndrome
1 twin sucks all nutrients - puts other twin at risk
when mom carrying twins+
* Increased risk of c section
* increased risk of maternal preeclampsia (hypertension can lead to seizures)
* Increased risk of maternal hemorrgage after birth
KNOW: more babies (at same time)= lower birthweight
We expect twins + to be born early
What is microcephaly?
Small head
Lots of things can cause microcephaly
* Toxoplasmosis
* Rubella
* Cytomegalovirus
* Herpes
* HIV
* Syphilis
* Zika
* Chromosomal or genetic abnormaltities
* Syndromes
* Exposure to a known teratogen (think known toxins)
Think viruses / STDs
Name the grades of the intraventricular hemorrhages
Grade 1: Bleeding in small area of the ventircles
Grade 2: Bleeding also occurs inside the ventricles
Grade 3: Ventricles are enlarged by blood
Grade 4: bleeding occurs in brain tissues around the ventricles
KNOW: Most women have anemia
What are the 3 things that happen w/ anemia during pregnancy
Pre term birth
Low birth weight
Post partum depression
Sometimes the mom will need a blood transfusion
What is Gestational diabetes
* When does it go away
* Does it cause big or small babies
* Does it increase or decrease the babies glucose #’s when they’re born
* What are the 2 things the baby is at risk for as an adult?
Type 2 diabetes that happens with pregnancy
Goes away as soon as the baby is delivered
Causes massive babies
decreases babies glucose levels at birth
Risk for obesity and type 2 diabetes as adults
* The mom is also at risk for type 2 diabetes
Treated w/ diet/EX
NOTE: Baby could also have breathing issues
What is preeclampsia and Eclampsia?
Preeckampsia High BP and signs of damage to another orgnan system, most often liver and kidneys
* If that BP is going up they’re at risk for seizures
* typically present w/ this general “I don’t feel good”
Eclampsia = onset of seizures after preeclampsia
KNOW: Hypertension rates are going up in general
